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MS Clin Med > Disorders and Treatments of The Spine > Flashcards

Disorders and Treatments of The Spine Flashcards

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1
Q

What are the functions of the Vertebral Column?

A

Supports the head and trunk, permits several types of movements, and protects the spinal cord in the vertebral canal.

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2
Q

How many bones are in the Vertebral Column of an infant and an adult?

A

33 separate bones in infants and 26 in adults.

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3
Q

What are the 4 curvatures of the Vertebral Column?

A

Cervical curvature (secondary), Thoracic curvature (primary), Lumbar curvature (secondary), Sacral curvature (primary).

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4
Q

What is the composition of the Vertebral Column?

A

7 cervical vertebrae
12 thoracic vertebrae
5 lumbar vertebrae
5 fused sacral vertebrae (Sacrum)
4 fused coccygeal (Coccyx)

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5
Q

What factors affect prognosis in spinal conditions?

A

1.Diagnosis is hard to identify

2.secondary gain
(work comp, MVA, interpersonal relationship),

3.psychosocial factors (tobacco, alcohol, education level, job satisfaction, depression).

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6
Q

What is the challenge of diagnosing spinal conditions?

A

Identifying the pain generator is nearly impossible; most back pain should be labeled as ‘non-specific’ in the absence of clearly discernable pathology.

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7
Q

What are indications for imaging studies for back pain?

A

Severe or progressive neurologic deficits

sudden back pain with spinal tenderness

trauma

serious underlying medical conditions.

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8
Q

What is the nomenclature for disc disease?

A

commonly used for herniated nucleus pulposus, prolapsed disc, ruptured disc, and torn annulus.

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9
Q

What characterizes a ‘normal’ disc?

A

Free of disease, trauma, and aging; however many ‘normal’ pain-free backs can have ‘abnormal’ discs.

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10
Q

What is an annular fissure?

A

Fissures in the annulus due to degeneration, aging, or trauma; seen in many people who do not have low back pain.

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11
Q

What is a bulging disc?

A

Generalized displacement of the disc tissue beyond the disc space

often a normal variant at L5/S1.
(bulging does not mean there will be symptoms)

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12
Q

What is a herniated disc?

A

Protrusion where the distance between the edges of the herniation is less than the distance at the edges at the base.

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13
Q

What is a herniated disc extrusion?

A

The distance between edges of herniation is greater than the distance at the base

often results in nerve root compression.

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14
Q

What is a herniated disc sequestration?

A

Displaced disc material has lost all connection with the disc of origin

may lead to leg pain only.

can also become reabsorbed

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15
Q

What is Schmorl’s node (intervertebral herniations)?

A

A portion of the disc projects through the vertebral end plate into the center of the vertebral body

common in minor degeneration of the aging spine.

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16
Q

What are major causes of Cauda Equina Syndrome?

A

Disc herniation, spondylosis

tumor

compression fractur

infection

ischemia

mechanical causes

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17
Q

What are degenerative diseases affecting the spine?

A

Disc degeneration, spondylosis, facet arthritis, stenosis, and spondylolisthesis.

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18
Q

What is spondylolisthesis?

A

The forward slippage of one vertebra over another.

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19
Q

What are the types of spondylolisthesis?

A

Isthmic (due to pars fracture or defect) common in adolescents

degenerative (most common in people over 65)-often grade 1 or 2

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20
Q

What are the grades of spondylolisthesis?

A

Grade 1: 0-25%,
Grade 2: 25-50%,
Grade 3: 50-75%,
Grade 4: 75-100%,

over 100% is spondyloptosis.

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21
Q

What is rheumatoid arthritis?

A

A systemic autoimmune disease diagnosed via blood tests; affects the synovial lining.

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22
Q

What are seronegative spondyloarthropathies?

A

Includes ankylosing spondylitis, psoriatic arthritis, and irritable bowel disease associated spondyloarthritis.

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23
Q

What is ankylosing spondylitis?

A

Reactive symptoms of sacroiliac joint pain and stiffness often begin during late adolescence or early adulthood.

diagnosed via xray and blood work

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24
Q

What is spondylolysis?

A

A congenital defect or non-displaced fracture of the pars interarticularis, usually at L5.

common in children and adolescents

often heals with rest

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25
What are compression fractures?
The most common type of spinal fracture due to osteoporosis, trauma, or tumor. often felt with a sudden onset of back pain that increases with standing or walking , pain decreases while lying on the back most common in thoracic-lumbar spine
26
What is a Jefferson fracture?
A burst fracture of C1, often caused by axial loading; usually does not result in neurologic compromise.
27
What are common spinal surgery procedures?
Discectomy, artificial disc replacement, laminectomy, fusion, kyphoplasty, and vertebroplasty.
28
What is discectomy?
The most common procedure for herniated discs; involves removing a portion of or all of the disc. an ambulatory surgery: avg time is 1-2 hours
29
What is artificial disc replacement surgery?
An alternative to spinal fusion for disc disease or herniation typically done for patients wuth disc disease at only one level
30
What is spinal fusion?
Most commonly performed for spondylolisthesis; involves fusing vertebrae together.
31
What are kyphoplasty and vertebroplasty?
Minimally invasive techniques to treat compression fractures; kyphoplasty involves balloon insertion and cement filling. vertebroplasty is bone cement injected under high pressure
32
What are common conservative treatments for back pain?
Education, medication, physical therapy, and bracing.
33
What are common medications for back pain?
OTC analgesics and NSAIDs prescription NSAIDs muscle relaxants neuromodulating medications.
34
What are targeted injections used for?
Pain relief, identifying pain generator, and promoting active rehabilitation.
35
What is radiofrequency ablation?
Used to treat painful facet joints by cauterizing the medial branch nerve.
36
What are the two types of curves?
lordsosis ( secondary) kyphosis (primary)
37
What are common symptoms of Spondylosis?
Episodic back pain and stiffness in the morning. Painful spinal joint movements
38
What is observed in X-rays of Spondylosis?
Spinal joint deformity.
39
What age group is most affected by Spondylosis?
Very common in ages 50 and older.
40
What are Spondylotic changes?
Loss of disc height and dehydration. facet hypertrophy hypertrophy of the posterior longitudal ligament bone spurs narrowing of foramen and or spinal canal
41
What is spinal stenosis?
Degenerative narrowing of the spinal canal, most often occurring after age 60.
42
What are the symptoms of spinal stenosis?
Symptoms include low back pain and neurogenic claudication (weakness and cramping in legs). symptoms better with flexed postures
43
What causes claudication in spinal stenosis?
Claudication is due to decreased blood flow to lumbar/sacral nerve roots.
44
What are early signs of RA?
low grade fever, muscle aches, fatigue
45
risk factors of ankylosing Spondylitis?
testing positive for the HLA-B27 marker family hx of AS frequent gastrointestinal infections
46
How is ankylosing Spondylitis treated?
with medication and PT
47
What aggrevates spondylolysis
extension and standing
48
how is spondylolsysis diagnosised
angle x ray bone scan CT MRI
49
who is at highest risk of compression fractures?
osteoporotic females older than 50 females are 4x more likely than men
50
How are compression fractures treated?
bracings, meds, PT, surgery
51
What causes jefferson fracture?
axial loading, diving injuries, and MVA
52
How is jefferson fracture treated?
halo brace
53
What are Odontoid (Dens) Fractures?
Most common type of C2 fracture; accounts for 10-15% of all cervical fractures.
54
In which patients are Odontoid fractures commonly seen?
Seen in young patients and elderly as a result of hyperflexion or hyperextension injury.
55
What are the symptoms of an Odontoid fracture?
neck pain and possibly difficulty swallowing due to hematoma; neuro signs not common.
56
How are Odontoid fractures treated?
Treated with bracing and/or surgery.
57
How is an Odontoid fracture diagnosed?
Best viewed via open mouth x-ray. CT helpful to determine type of fracture. MR indicated when neurological findings are present.
58
What is a Hangman’s Fracture?
Traumatic Spondylolisthesis of C2 due to hyperextension injury.
59
In what situations are Hangman’s fractures common?
Common in diving accidents, falls, and MVAs.
60
How are Hangman’s fractures typically treated?
Most often treated with stabilization vs. surgery.
61
what are some surgical considerations before operating on the spine ?
these surgeries are elective use least invasive procedure that will accomplish goals do the benefits outweigh the risks?
62
What is an indication for emergency spine surgery?
progressive neurologic deficit in the presence of a surgically correctable lesion
63
What is decompression surgery?
typically indicated for spinal for spinal stenosis but is also done for herniated discs involves removal of laminae
64
types of spinal fusions?
Anterior Lumbar Interbody Fusion (ALIF) Posterior Lumbar Interbody Fusion (PLIF) Transforaminal Lumbar Interbody Fusion (ALIF)
65
66
What is the Future of Regenerative Medicine?
moving towards prolotherapy, platelet rich plasma injections, and stem cell treatment
67
What is Prolotherapy?
Prolotherapy is the injection of an irritant solution used to trigger a healing response.
68
What are Platelet-Rich Plasma (PRP) Injections?
PRP Injections involve the injection of the patient’s platelets to stimulate healing. ## Footnote Commonly used for tendons, muscles, ligaments.
69
What are Stem-cell treatments?
Stem-cell treatments involve the injection of stem cells to promote healing.

MS Clin Med (7 decks)

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